Period absence can be a sign of a uterine or ovarian problem or dysfunction of the hypothalamic-pituitary regulatory axis. PCOS is among the most common endocrine disorders that results in cycle irregularity. In the case of PCOS, increased ovarian androgen production is the cause. The next step is to evaluate prolactin levels and perform thyroid-function tests. Mild hyperprolactinemia is often detected in women with PCOS.
The laboratory testing done for absence of period (termed as secondary amenorrhea) should include measurements of serum prolactin, androgens, thyrotropin, and FSH to test for hyperprolactinemia, thyroid disease, and ovarian failure. Causes of absence of period are;
1) Ovarian hormone dysfunctions
2) Thyroid hormone abnormalities
3) Stress, anxiety, emotional disorders
4) Sudden weight loss or gain
5) Excessive physical activity
If all the hormonal and above causes are ruled out, one of the most common types of secondary amenorrhea is functional hypothalamic amenorrhea, which by definition rules out pathologic disease. In this there is a decrease in hypothalamic gonadotropin-releasing hormone (GnRH) secretion. Multiple factors may contribute to the pathogenesis of functional hypothalamic amenorrhea, including eating disorders, exercise, and stress. However, in a few women with functional hypothalamic amenorrhea no obvious precipitating factor is evident (this might be true in your case). Consultation with an endocrinologist (if noot yet done) is necessary for performing an adrenocorticotropic hormone (ACTH) stimulation test or for other causes of menstrual irregularity such as thyroid disease or pituitary adenoma.
Following would help in PCOS, meanwhile;
1) Weight reduction, if over weight. Loss of abdominal fat seems to be crucial to restore ovulation. If it is morbid obesity, Bariatric surgery may be advised. Otherwise dietary counseling and exercise would help in short and long term.
2) FSH stimulation with clomiphene HMG or pulsatile LHRH.
3) Reduction of ovarian androgen secretion by using oral contraceptives or LH-releasing hormone (LHRH) analogs.
4) Urofollitropin (pure FSH) administration.
5) Reduction of ovarian androgen secretion by laparoscopic ovarian wedge resection. Laparoscopic ovarian surgery (laparoscopic ovarian drilling) is a useful alternative that does not trigger ovary stimulation.
6) Metformin improves ovulation, insulin sensitivity.
First-line medical therapy usually consists of an oral contraceptive to induce regular menses. If this is not helping, endocrine evaluation by a endocrinologist would be paramount.
Please feel free for your follow up questions.
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